Severe injury and major operation often lead to traumatized, even multiple traumatized patients. In treating such patients, a general anesthesia is generally used. During such an operation, the intestines of the patient may be put to sleep and result in paralytic ileus, or paralysis of the bowel. It is also not uncommon for a severe injury, such as a head injury received in an automobile accident, to involve a disruption of the gastric emptying function of the patient.
In either or a combination of the above events, the decrease or loss of function makes it necessary for purposes of effective treatment and patient safety, to decompress the stomach of the patient and begin a sump operation within a short time, and maintain the stomach in that state until gastric emptying renews and stabilizes. Also, at times the best treatment calls for a lavage operation by introduction of a cleansing solution to help remove material from the stomach. In order to achieve the emptying and/or cleansing of the stomach, it is standard medical practice to intubate the patient with a sump/vent tube. As shown in U.S. Pat. No. 2,614,563 to Devine, Jr., a tube employs air vent/suction for providing an effective pressure equalization and drain of the stomach and includes two separate passageways to do this. Specifically, the first passageway acts as an air vent or in-flow lumen, while suction is applied to the second passageway. The introduction of the air through the first passageway is essential to the employing of suction to empty the stomach. The air vents the stomach to ambient pressure to prevent the stomach from collapsing and the delicate sidewalls from being drawn into the opening of the suction passageway, thereby allowing efficient material passage from the stomach. To perform these functions, both passageways of the Devine device terminate in the stomach of the patient.
The decompressing and sump operations of the stomach, however, may not be the only concern for proper patient treatment. For example, it is known that caloric requirements of head-injured patients show a significant correlation with the severity of brain damage. Thus, early nutrition in severely head injured patients contributes signficantly to positive treatment.
Nutritional support in such cases has been traditionally provided by enteral feeding i.e. feeding direct into the stomach. When a conventional sump tube, as disclosed in Devine, Jr., is utilized, enteral feeding is delayed until good gastrointestinal function returns in the post injury period. Once gastrointestinal function returns in, for example, 4-8 days, it becomes necessary to remove the sump tube and proceed with a second, separate intubation of a feeding tube. Disadvantageously, this second intubation may traumatize the patient physically, as well as emotionally, if the patient is conscious or has periods of consciousness.
Further, it may be difficult if not impossible to perform the second intubation if the patient has a nasotracheal, endotracheal or tracheostomy tube. In such a case, the feeding tube may coil in the back of the patient's mouth. There is also the additional risk of doing damage to the mucous membranes in the nose and lining of the esophagus. Feeding tubes with stylets also increase the risk of inadvertent rupture of the tracheal or endotracheal cuffs. Further, feeding tubes with stylets may increase the risk of possible damage to the mucosa of the esophagus if the stylet should pass through the end or side port of the tube during intubation. Lastly, even if the second intubation is successful without any of the complications discussed above, it takes an additional period on the order of 48 hours for the normal digestive process to extend the intubated feeding tube from the stomach into the duodenum for purposes of enteral feeding. This additional delay of two days or more until nutritional support is received adversely affects the recovery, indeed the chances of survival, of the patient.
Thus, in order to provide nutritional support to patients in a shorter amount of time, other feeding methods have been proposed. One method requires surgically implanting a duodenal feeding tube in the patient. Such a procedure, however, disadvantageously exposes the already traumatized patient to additional surgery with its own trauma and risks of infection. A second alternative method involves parenteral feeding through the veins. This requires the use of a percutaneous intraclavicular subclavian vein catheter. The catheter is usually positioned in a vein in the patient's shoulder. Disadvantageously, however, this second method is very expensive, involves an increased risk of infection and is beset with other complications.
In light of the above, a need is identified for an apparatus especially adapted for post injury use to allow both a sump/lavage function and in addition an early feeding function in a single intubation. The apparatus should also provide both improved patient safety and comfort.